HomeMy WebLinkAboutBLD29241 Mobile Home - BLD Application - 10/9/1991 -� BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W.CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584 n
427-9670 DATE ISSUED!�v✓�_-
PERMITNO. �-�'� J4/p
NAME MAIL ADD S CITY&STATE ZIP PHONE
OWNER vz 9�p
DIRECTIONS �� h I I I `�f lc)�TO JOB SITE
. , e, oclh� (Sol 1
PARCEL LEGAL _ `s� I L4 , \J i ILI
NUMBER DESCR. I �
CONTRACTOR \_
AME MAIL ADDRESS CITY&STATE ZIP PHONE LICENSE NO.
Q
USE
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK
WORK DESCRIBE O �Vcflq
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE f,20SgFt STORIES SHORELINE O- CONDITIONING.
BASEMENT SgFt BEDROOMS 4� PRIMARY RES.h// THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS SgFt BATHROOMS _� SEASONAL RES.❑ COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED 0 DETACHED❑
OWNERSAFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION LAW RCW 18,27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
XOWNEFjo ,HE"' DATE vl-' X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO / ^
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE L4 .0
APPLICATION ACCEPTED BY I PLANS CHECK APPRO E FO ISSUANCE TOTAL
PERMIT VALIDATION c-
_)
-C IBY CASH CK MO
BUILDING PERMIT PLOT PLAN
MASCN COUNTY
0EFAF IMENT of GENEFA,L SERVICES
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_ O Septic t2rx an-�rair.`ie!d san:ac`.<�is:dRc2s frcn fcur.dzd ices.
a Lcic_tics of proposed cans:ructicn or, property.
O Euil(ti.—z $ septic srs::r; set: ezck Cis:crtces frcm a!I pr;party Rnas a easerents.
IRdiC3tp NQr::T Q. 5��.11 va r takes, rivers, str2a,:'ZS,w tzr-,d ge in Circle �.•c. C{rc.Rc��.
Q A;.aeh copy of septic system`as bui; or septic perit"appr`vel -
O lr eic=_te ;ocoCraphy profile of praper<Y zRC st,.c;ure cn-reverse scG`_.
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